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Table 2 Country-recommended priority actions for addressing common bottlenecks to scaling up antenatal corticosteroids.

From: Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Health system building block Sub-category Priority actions
Leadership and governance Policy and guidelines • Develop, update and disseminate the national policy on prevention and management of preterm labour; this should include policy on ACS use
• Advocate for newborn health to be made as a priority
• Develop national clinical protocols and guidelines on management of preterm labour
Health financing Funding/budget allocation • Increase funding / budget allocation for newborn care
• Advocate and lobby for more funding from partners in newborn health
  Cost of antenatal corticosteroids • Assess financial implications and develop financial policy for supplies and services to deliver this intervention to beneficiaries
• Include antenatal corticosteroids as part of the free MNCH policy
• Scale up obstetric kits by including relevant newborn drugs such as antenatal corticosteroids
Health workforce Policy restriction for prescription and administration • Authorise all skilled births attendants to prescribe and administer ACS
  Job descriptions/job aids • Develop and disseminate job aids
  Shortage of qualified staff • Recruit and train competent health providers
• Develop an electronic database to track training activities and identify needs
• Ensure staffing norms are in line with WHO recommendations
  Competency and training • Strengthen competency based pre-service and in-service training, and on job training to capture use of ACS by health providers for fetal lung maturation
• Include ACS training in skilled birth attendant evaluation
Health service delivery Service availability • Develop and disseminate national guidelines in health facilities
• Establish follow-up visits to monitor availability and use of ACS in all health facilities
  Quality of care • Establish a supportive supervision and mentoring mechanism with a reward system;
• Regular integrated monitoring visits to ensure compliance to protocols;
• Integrate ACS use in clinical audits and reviews;
  Referral systems • Involve all stakeholders to improve infrastructure for timely referral (road network)
• Build district-level capacity to monitor appropriate use of ambulances and ensure adequate maintenance
Essential medical products and technologies Procurement policy • Include ACS in national essential medicines list with appropriate indication (fetal lung maturation)
  Drug availability • Develop and disseminate policy in health facilities to enhance procurement
  Logistics management information systems (LMIS) • Estimate needs based on number/estimate of preterm birth load at health facilities
• Build staff capacity for logistics management
Health information system Data collection and reporting • Define indicator(s) for tracking ACS use and incorporate into national system
• Strengthen monitoring mechanisms such as regular monitoring and evaluation visits, documentation through use of program data.
• Conduct regular review meetings on data management at all levels
Community ownership and participation Knowledge / awareness • Conduct integrated community maternal and newborn education and campaigns in local languages
• Improve community awareness on newborn health by adding newborn information to maternal awareness documents, campaigns, media, etc.
  Community participation / engagement • Strengthen community leaders and male involvement through innovative approaches;
• Strengthen functioning of existing community units with nationwide community awareness initiatives on newborn health
• Health facilities to come up with innovative ways of involving men e.g. set aside time for couples during antenatal visits and time for adolescents
  Demand for preterm birth care • Scale up tribal empowerment project to address socio-cultural barriers to newborn care
• Utilise community radio and mobile applications